tbuckley/cabot-search huggingface dataset:
Abstract 9368: Association Between Concurrent Use of Amiodarone and DOACs and Bleeding Risk in Atrial Fibrillation Patients
Authors: Mohammed Shurrab, Cynthia Jackevicius, Peter Austin, Karen Tu, Feng Qiu, Sheldon Singh, Eugene Crystal, Joseph Caswell, Faith Michael, Jason Andrade, Dennis T Ko
Journal: Circulation (2022)

Introduction: Amiodarone is a commonly used pharmacotherapy in patients with atrial fibrillation (AF) with potential for drug-drug interactions (DDIs) with direct oral anticoagulants (DOACs). We aimed to assess the bleeding risk after co-prescription of amiodarone and DOACs among adults with AF. Methods: We conducted a population-based, nested case-control study in Ontario, Canada. The study population included all patients with AF &gt; 66 years on a DOAC between April 1, 2011-March 31, 2018. Cases were patients admitted with major bleeding (index date). Controls were matched in a 2:1 ratio to cases. We categorized exposure to amiodarone before the index date as: a) current users (amiodarone within 60 days); b) past users (amiodarone within 61 to 140 days); and c) unexposed (no amiodarone prescription or amiodarone prescription &gt;140 days before index date). Conditional logistic regression models were used to examine the association between bleeding and amiodarone co-prescription. Results: Among 86,679 AF patients on a DOAC, we identified 2,766 cases (3.2%) admitted with major bleeding. The median age of AF patients was 80 years (interquartile range 75-85); 48.3% were women. After multivariable adjustment, there was a significant association between major bleeding and current use of amiodarone (adjusted odds ratio (aOR) 1.53; 95% confidence interval (CI) 1.24-1.89, p&lt;0.001) but no significant association between major bleeding and past use of amiodarone (aOR 1.13, 95% CI 0.76-1.68, p=0.545) as compared with the unexposed group. Conclusions: Among older patients with AF on a DOAC, there was 53% increased odds of current use of amiodarone in those with versus without major bleeding.
Abstract 9391: Early Biomarkers to Predict a Worse Outcome After Acute Myocardial Infarction: Circulating Infectious Extracellular Vesicles From Archaea and <i>M. Pneumoniae</i> Are Present and Correlated to Cytokines IL-6 and IL-10
Authors: Camila R Moreno, Alexandre M Soeiro, Maria N Sato, Jaqueline J Pereira, Renata N Ikegami, Joyce T Kawakami, Marcia M Reis, Luanda M Oliveira, Maria Lourdes Higuchi
Journal: Circulation (2022)

Acute myocardial infarction (AMI) is related to rupture of atheroma plaques containing pro-inflammatory cytokines, oxidized low-density lipoprotein (oxLDL) and MMP9, a microenvironment compatible with the presence of a pathogenic microbial community. Recently, infectious extracellular vesicles (iEVs) were discovered to be released in co-infections. Previously, we found iEVs positive for archaea DNA and Mycoplasma pneumoniae (Mp) antigens in vulnerable plaques. Now, looking for serum particles biomarkers to differentiate atherosclerotic clinical outcomes we studied 168 patients (pts) from groups: Atherosclerotic (ATR), AMI, AMI with major severity (sAMI) and healthy (CTL) Methods: We quantified and characterized serum iEVs ( 0.79-1.34 μm) through their content using the Flow Cytometry technique and for cytokines using CBA kit, for exosomes (&lt;100nm) we used Nanosight equipment and for correlations we used Spearman 's test. Results: sAMI pts sera presented increased no. of iEVs positive for archaea DNA and Mp, MMP9, IL6 and IL10 cytokine antigens. TNFα was increased in CTL and ATR compared to both AMI groups. TNFα correlated with archaeal IEVs in sIAM group. There was a significant positive correlation between Mp and MMP9 in the AMI, CTL and ATR groups. A significant positive correlation was present between Mp and IL6 in AMI and sAMI groups. ATR and CTL groups had higher no. of exosomes than the sAMI group. Conclusion: Increased numbers of serum IEVs positive for archaea, Mp and MMP9 elements in association with increased levels of IL6, decreased numbers of protective exosomes and correlation between TNF-α vs archaea, are present in sAMI clinical outcome, which suggests that serum IEVs and cytokines levels may constitute new biomarkers to differentiate atherosclerotic clinical outcomes.
Abstract 9403: Sex Differences in Clinical Features, Utilization of Oral Anticoagulant Agents and One Year Outcome in the Middle East. the Jordan Atrial Fibrillation Study
Authors: Mohamad Jarrah, Ayman J Hammoudeh, Badaineh Yahya, Ramzi Tabalat, Yousef Khader, Haneen Shawer, Imad Alhaddad
Journal: Circulation (2022)

Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia in women and men on a global level. Sex-specific differences in the baseline clinical and demographic features, management strategies and prognosis in patients with AF have been studied extensively but have received less attention in the Middle East Hypothesis: To compare the clinical characteristics, therapeutic strategies and one-year incidence of major cardiovascular events between women and men with AF Methods: The Jordan AF Study enrolled consecutive patients with AF in 29 hospitals and cardiology clinics in Jordan from May 2019 through December 2020. Patients were followed up for one year. We used the study data to compare clinical features, use of pharmaceutical agents and outcome in women compared with men Results: Of 2020 AF patients enrolled, 1095 (54.2%) were women. Women were older than men (mean age±SD 69.4±11.1 vs. 66.0±14.7 years, p&lt;0.001), and had higher prevalence of hypertension, diabetes, and obesity. Compared with men, women with nonvalvular AF had higher mean CH2DS2-VASc score(4.1±1.7 vs. 3.0±1.8, p&lt;0.001) and HAS-BLED score (1.7±1.1 vs. 1.6±1.2, p=0.05). High-risk CHA2DS2-VASc score was present in 83.9% of women and 78.9% of men (p=0.07), and oral anticoagulant agents were prescribed for 84.7% of women and 81.7% of men (p=0.14).At one year, women and men did not differ significantly in rates of all-cause death (12.0% vs. 13.1%, p=0.51), stroke/systemic embolism (4.1% vs. 4.8%, p=0.44), major bleeding events (2.0% vs. 3.2%, p=0.13), and intracranial bleeding (0.3% vs. 0.8%, p=0.24). Multiple logistic regression analysis showed no sex differences in one-year all-cause death. Moreover, age &gt; 70 years, hypertension, diabetes, heart failure, ischemic heart disease were associated with higher incidence of all-cause death Conclusions: Despite the fact that Middle Eastern women with AF had worse baseline clinical profile and risk scores, they did not differ from men in one-year outcome. Female sex was not a predictor of one-year mortality in this cohort.
Abstract 290: Early Monitoring Of Neurological Recovery Using Poincare Analysis Index Of Heart Rate Variability - A Potential Biomarker For Asphyxial Cardiac Arrest Related Brain Injury
Authors: Prachi Agarwal, Romergryko Geocadin, Nitish Thakor
Journal: Circulation (2022)

Heart rate variability (HRV) is influenced by autonomic nervous system including subcortical structures such as brainstem. We hypothesized that HRV would reflect graded response to hypoxic ischemic brain injury after cardiac arrest (CA). We investigated HRV based on the Poincare analysis method during the hyperacute recovery period after resuscitation to define its role in assessing neurologic recovery. Adult male Wistar rats (360±20g) were subjected to either 5 /7-min of asphyxial CA and grouped based on neurologic recovery - good (n=17) and bad (n=16), assessed at 4 hr post resuscitation using a standardized Neurological Deficit Scale (NDS). A good outcome (GO) was defined as a NDS sub score (arousal+brainstem) of 36-40 and bad outcome (BO) as 23-35, with 40 as good and 0 as brain dead. A Poincare plot showing successive heart rate intervals was developed and analysed on 5-min ECG segments (first 1 hr) owing to the nonstationary HRV patterns during early recovery period. Several machine learning models were trained to assess the results from the standard deviations (SD1, SD2), to decipher the parasympathetic and sympathetic activities, and evaluated by the area under receiver operating characteristic curve (AUC). GO group demonstrated an NDS of 39.65±0.99, while the BO group had an NDS of (30±2.65) showing a statistical difference between groups (p&lt;0.01). GO group exhibited an immediate increase post resuscitation in SD1 (0.55±0.23) and SD2 (0.67±0.29) with a gradual decrease ~1 hr, SD1 (0.20±0.12) and SD2 (0.13±0.09). No significant differences in initial SD1 (0.30±0.14) and SD2 (0.28±0.16) vs after 1 hr of recovery (SD1 (0.29±0.08), SD2 (0.30±0.16)) were observed across BO group. For GO, all parameters indicated a faster return to baseline values- SD1 (0.21±0.08) SD2 (0.15±0.16), showing a better recovery of the cardiac autonomic control, in agreement with the evolution of NDS. Logistic regression and naïve bayes performed best with SD2, giving an accuracy of 72% (AUC: 0.75) and 75% (AUC: 0.88) for recovery prognostication in 5-fold cross validation. Unlike previous studies to find biomarkers for CA related brain injury focused on cortical assessment, our results indicate that the novel HRV method can fill the gap in assessing subcortical injury after CA.
Abstract 9278: No Improvement in the Operative Outcomes of Women Undergoing Coronary Artery Bypass Surgery in the United States, 2011-2020
Authors: Mario F Gaudino, David M Chadow, Mohamed Rahouma, Giovanni Soletti, Sigrid Sandner, ROBERTO PEREZGROVAS OLARIA, Katia Audisio, Gianmarco Cancelli, Brenden Bratton, Stephen E Fremes, Paul Kurlansky, Leonard N Girardi, Robert H Habib
Journal: Circulation (2022)

Background: Women undergoing coronary artery bypass grafting (CABG) have significantly higher mortality and morbidity compared to men. While on a national level overall mortality after CABG has significantly decreased over the last decade, it is unclear if this trend of improvement applies to women. Objective: The aim of this analysis was to evaluate trends in outcomes of women undergoing CABG in the United States over the course of the last decade. Methods: The data for this study was provided through the STS Participant User File research program. Patients were included in the analysis if they underwent primary isolated CABG during the study period. Patients requiring resuscitation prior to surgery, emergent/salvage operations, and reoperation were excluded. The primary outcome was operative (30-day) mortality. The secondary outcome was the composite of operative mortality and morbidity (including operative mortality, stroke, renal failure, reoperation, deep sternal wound infection, prolonged mechanical ventilation, prolonged hospital stay). For all the outcomes, the STS definitions were used. The attributable risk (the effect of female sex on CABG outcomes) for the primary and secondary outcomes was calculated. Results: Between 2011 and 2020, 1,297,204 patients underwent multivessel CABG, 317,716 (24.5%) of which were women. The proportion of women decreased from 26.2% in 2011 to 22.7% in 2020 (P for trend &lt;0.001). Women had a higher unadjusted operative mortality (2.8% vs 1.7%, P &lt;0.001) and overall unadjusted incidence of the composite of operative mortality and morbidity (22.9% vs 16.7%, P &lt;0.001) compared to men. The attributable risk of female sex for operative mortality varied from 1.28 in 2011 to 1.41 in 2020, with no significant change over the study period (P for trend=0.37). The attributable risk for the composite of operative mortality and morbidity was 1.08 in 2011 and 2020, with no significant change over the study period (P for trend=0.71). Conclusion: Female sex remains an independent risk factor for adverse outcomes following CABG and no significant improvement has been seen over the course of the last decade. Further investigation into the determinants of operative outcomes in women is urgently needed.
Abstract 9449: Increased Neprilysin Expression Links Atrial Fibrotic Remodeling in Cardiovascular Surgery Patients
Authors: Toshiaki Nakajima, AKIKO HARUYAMA, Taira Fukuda, Kentaro Minami, Syotaro Obi, Shu Inami, Masashi Sakuma, Shichiro Abe, IKUKO SHIBASAKI, Hirotsugu Fukuda, Shigeru Toyoda
Journal: Circulation (2022)

Introduction: Deposition of extracellular matrix (ECM) such as collagen leads to fibrosis, which plays essential roles in structural remodeling in atrial fibrillation (AF). Neprilysin (NEP) is an integral membrane-bound metallopeptidase with a wide spectrum of substrates and physiological functions. Hypothesis: We investigated the association of NEP and the atrial fibrosis-related genes in cardiovascular surgery patients including heart valve disease. Methods: Atrial mRNA expression including collagen and NEP were analyzed by real-time reverse transcription polymerase chain reaction (RT-PCR) in 59 cases (sinus rhythm (SR) 24 patients, AF 35 patients) in which LA tissues were removed from the appendage during surgery. NEP mRNA expression was also analyzed in adipose tissues (AT) obtained from both epicardial and subcutaneous adipose tissues. The NEP protein expression was measured by western blotting analysis and immunohistochemistry staining, and serum level of NEP was measured by ELISA. Results: The immunohistochemical staining showed the expression of NEP in both AT and LA. Higher expression of NEP mRNA and protein in adipose tissues was observed, compared with LA. Serum NEP concentration did not significantly correlate with NEP mRNA and protein expression of AT and LA. The significant correlations were observed among ECM (COL1A1, COL3A1, fibronectin) and the five selected fibrosis-related genes (TGFβ1, CTGF, miR21, NOX2 and BAX) attributed to the fibrosis of myocardium in LA. NEP mRNA expression of LA also positively correlated with the ECM and the fibrosis-related gene expression level. The multiple regression analysis revealed TGFβ1, NOX2, and NEP as independent predictors of atrial COL1A1 mRNA expression level. In addition, it revealed NEP as an independent predictor of COL1A1 mRNA expression level, even adjusted by age, sex, and BMI. Serum NEP concentration did not correlate with the ECM and the fibrosis-gene expression level. Patients with AF had higher atrial expression of NEP protein, compared to those with SR. Conclusions: Increased atrial expression of NEP links atrial fibrotic remodeling and developing AF in cardiovascular surgery patients. However, serum NEP did not reflect atrial NEP expression in LA.
Abstract 303: Evaluating The Utility Of A Predictive Analytic For Reducing Intensive Care Unit Readmissions
Authors: Bryce Benson, Sooin Lee, Ashwin Belle
Journal: Circulation (2022)

Background: The reported incidence of readmission (bounceback) to the ICU ranges from 4% to 10% of the total number of ICU admissions. Studies have shown that patients readmitted to the ICU have significantly higher mortality rates, longer lengths of stay, and higher costs than patients who survive the ICU and are not readmitted. Being able to tell whether patients have high or low risks of returning to the ICU could help physicians optimize the timing of ICU discharge. Hypothesis: A single lead continuous ECG based real-time analytic can help reduce ICU readmission rates. Methods: This retrospective analysis considered any admission back to the ICU following transfer to a lower-level care during the same hospitalization as an ICU Readmission. This study included 65 consecutive Michigan Medicine ICU patients who were transferred to a lower level of care and had ECG waveforms collected in real time. The Analytic for Hemodynamic Instability – Predictive Indicator (AHI-PI) processed the ECG to predict the likelihood of a future episode of hemodynamic instability with High, Moderate, and Low Risk indicators, which are updated every 2 minutes. Results: Of the 65 consecutive patients transferred from ICU to a lower-level of care, 14 patients (22%, 14/65) had AHI-PI High Risk indication prior to transfer. The remaining 51 patients (78%, 51/65) had AHI-PI Moderate or Low Risk indication prior to transfer. Of the AHI-PI High Risk indicated subgroup, 29% of patients had ICU Readmissions. In the other subgroup, only 10% did. This means that physicians with access to AHI-PI Risk indicators could potentially reduce ICU Readmission rates by 66% (from 29% to 10%). Further, the subgroup with no AHI-PI High Risk indication had an average of 73 hours (median 41 hours) of AHI-PI Moderate or Low Risk indication prior to transfer. Conclusion: Results indicate that patients with AHI-PI High Risk indication prior to transfer had higher risks of ICU Readmission, compared to those without. Prolonged AHI-PI Moderate or Low Risk indication prior to transfer can potentially help physicians decide to transfer patients earlier than otherwise. This can ultimately help reduce lengths of stay and improve bed and resource utilization in the ICU. Footnote: AHI is an FDA-cleared device for sale in the US.
Abstract 9396: Calmodulin-Dependent Protein Kinase II Activation Promotes Kidney Mesangial Expansion in Streptozotocin-Induced Diabetic Mice
Authors: Alexei V Mikhailov, Heng-Jie Cheng, Jen-Jar Lin, Che Ping Cheng
Journal: Circulation (2022)

Background: Calmodulin-dependent protein kinase II (CaMKII) is upregulated in diabetes mellitus (DM), leading to the overproduction of collagen in the myocardium. We hypothesized that CaMKII also stimulates the extracellular matrix production in the kidneys leading to mesangial matrix expansion, a hallmark of diabetic nephropathy and a major cause of renal failure. To test this hypothesis, we developed an automated process of mesangial matrix measurement. Methods: We induced Type 1 diabetes (DM1) in wild type female FVB mice via an intraperitoneal injection of Streptozotocin (STZ, 200 mg/kg ip) and studied the dynamics of mesangial matrix fractional area (MMFA) over 10 weeks (W) in mice with: DM , DM/KN93 , 6 W after STZ, followed by 4 W treatment with a CaMKII inhibitor KN93 (70 μg/kg/day, via mini pump), and Control (C) (vehicle only) mice. Both kidneys were retrieved. MMFA measurements were performed on 50 glomeruli from each animal on trichrome-stained paraffin sections using a trainable segmentation WEKA (Waikato Environment of Knowledge Analysis) plugin for Fiji, as well as on the electron micrographs of 4-5 whole glomeruli/animal. Results: Both DM and DM/KN93 mice were severely hyperglycemic (517 and 538 mg/dL compared to 161 mg/dL in C). In DM mice, the kidney weight increased by 76% and the MMFA significantly increased by 81% compared to C (9.4 ± 1% vs 5.2 ± 2.8%). In DM/KN93 mice, MMFA was similar to that in controls (6.2 ± 2.3%). The electron microscopy study has confirmed these MMFA changes. Other features of human diabetic nephropathy were not seen and the fractional mesangial cell area and the fractional podocyte area were relatively unchanged in DM and DM/KN93 mice. Conclusions: Our DM1 mouse model reproduces the key features of early human diabetic nephropathy. KN93 prevents DM-induced extracellular matrix production and kidney mesangial matrix expansion, suggesting that chronic inhibition of CaMKII could be a potential treatment for the early diabetic nephropathy. Reliable automated measurement of the MM area can be achieved after training by the WEKA plugin.
Abstract 307: Kids Save Hearts Project: Hands-only Cardiopulmonary Resuscitation Training For Schoolchildren
Authors: Isabella Bispo Diaz Toledo Martins, Giuliana Simões Nakano, Manuela Simões Nakano, Pedro Silva, Vinicius Rossignoli, Rafael Batista, Thiago Cardoso, Francine Ramos, Leonardo Medeiros, Tereza Lais Zutin, Emílio dos Santos, Julia Romão, Miguel Florentino, Nayla Girotto, Yuuki Tahara, Gabriel Cunha, Uri Flato, Helio Penna Guimaraes
Journal: Circulation (2022)

Introduction: As part of a global initiative, several countries already provide cardiopulmonary resuscitation (CPR) training to children in school environments. This training is not a part of the Brazilian school curriculum, but it is necessary since cardiorespiratory arrest events are frequently fatal. Objective: This study investigates the effectiveness of hands-only cardiopulmonary resuscitation among different age groups of schoolchildren. Methods: The institution's research ethics committee previously approved the study. Prior to training, both parents and participants signed a consent form. This study was conducted in three (public and private) schools using a quasi-experimental intervention with two age groups: 7 to 11 (group I) and 12 to 17 (group II). The 90-minute training module consisted of short practice videos while watching a song dedicated to "hands-only CPR." Students were then individually evaluated for their skills and knowledge using Skill Reporter Software Laerdal Medical during one minute of chest compressions on a manikin and a dedicated game. Results: The total of 102 schoolchildren (54 females and 48 males) (table1) were trained and evaluated for demographic variables (rate, depth, recoil) and chest compression quality according to international guidelines 2020. There were differences in the physical characteristics of participants (p&lt;0.05) and significant statistical difference related to depth in CPR (median 66 mm; p: 0,01) in group II. Conclusion: It was concluded that schoolchildren performing hands-only cardiopulmonary resuscitation were adequate, and those future efforts are required to implement and expand training in low-income regions of Brazil.
Abstract 302: Esophageal Saturation Monitoring More Accurately Detects Severe Tissue Hypoxia Than Near-infrared Spectroscopy
Authors: Kristen Sack, Julia Garcia Mancebo, Padraic Romfh, John Kheir
Journal: Circulation (2022)

Introduction: Balance between oxygen delivery and demand is typically assessed based on venous oxyhemoglobin saturation (SvO2), which requires repeated blood sampling from a central location. Alternative, non-invasive methods such as near-infrared spectroscopy (NIRS) demonstrate poor sensitivity to tissue hypoxia. Methods: We explored the possibility of measuring regional tissue oxyhemoglobin saturation in the esophagus (EsSO2) using a new, linear probe using resonance Raman spectroscopy (RRS, 420 nm excitatory light, A) to quantify the fraction of oxyhemoglobin. The RRS probe was passed from the mouth into the mid-esophagus in Yorkshire swine (n=7, weight 11.2-13.4 kg). Cerebral (cNIRS) and splanchnic NIRS (sNIRS, Somanetics) were continuously recorded. Swine underwent complete asphyxia by endotracheal tube occlusion for 12 minutes, during which time they were resuscitated using CPR and drugs. EsSO2, cNIRS, sNIRS were compared with SO2 based on arterial blood gas co-oximetry (SaO2). For the purpose of analysis, SaO2 was considered functionally equivalent to SvO2 due to the obligate intrapulmonary (veno-arterial) shunting in this physiology. Results: During asphyxia, SO2 rapidly declined to nearly 0%. This was reflected in EsSO2, but cNIRS and sNIRS decreased to a lesser extent (B). EsSO2 exhibited a strong correlation with SO2 (r 2 =0.63, p&lt;0.001) compared to sNIRS (r 2 =0.53, p&lt;0.001) and cNIRS (r 2 =0.06, p=0.106, C). Defining SO2 &lt;30% as the presence of critical hypoxia, EsSO2 had a higher sensitivity than both the sNIRS and cNIRS (D). EsSO2 was &lt;30 in 100% (33/33) of timepoints in which critical hypoxia was present, significantly more sensitive than rSO2 based on cNIRS (which was &lt;30 in 58% (19/33) of timepoints) and sNIRS (&lt;30 in 24% (8/33) of timepoints). Conclusion: EsSO2 accurately detects critical hypoxic states, more so than cNIRS or sNIRS, and may represent an alternative, continuous, less invasive approach to central venous monitoring.